المؤلفون: Seaton, R A, Ritchie, N D, Robb, F, Stewart, L, White, B, Vallance, C

المصدر: Journal of Antimicrobial Chemotherapy ; volume 74, issue 8, page 2119-2121 ; ISSN 0305-7453 1460-2091

الوصف: Bone and joint infection contributes significantly to clinical activity within outpatient parenteral antimicrobial therapy (OPAT) services. The OVIVA (oral versus intravenous antibiotics for bone and joint infection) randomized study has challenged the practice of prolonged intravenous therapy, because non-inferiority of oral antibiotic therapy was demonstrated, thereby implying that early transition to oral therapy is an appropriate alternative to prolonged intravenous therapy. We examine the caveats to the study and discuss the implications for OPAT practice, highlighting the importance of careful oral antibiotic selection with attention to bioavailability, bone penetration, drug interactions, compliance and toxicity monitoring. We emphasize that ambulatory antibiotic therapy (whether intravenous or oral) in this patient group requires expert multidisciplinary management, monitoring and follow-up, and ideally should be undertaken within existing OPAT or, more accurately, complex outpatient antibiotic therapy (COpAT) services.

الإتاحة: https://doi.org/10.1093/jac/dkz122Test
http://academic.oup.com/jac/article-pdf/74/8/2119/28963198/dkz122.pdfTest

المؤلفون: Barr, D. A., Irvine, S., Ritchie, N. D., McCutcheon, J., Seaton, R. A.

المصدر: QJM ; volume 107, issue 3, page 207-211 ; ISSN 1460-2725 1460-2393

مصطلحات موضوعية: General Medicine

الإتاحة: https://doi.org/10.1093/qjmed/hct239Test
http://academic.oup.com/qjmed/article-pdf/107/3/207/4467549/hct239.pdfTest

المؤلفون: Ritchie, N. D., Lovering, A. M., Seaton, R. A.

مصطلحات موضوعية: Research letter

وصف الملف: text/html

العلاقة: http://jac.oxfordjournals.org/cgi/content/short/dkq122v1Test; http://dx.doi.org/10.1093/jac/dkq122Test

الإتاحة: https://doi.org/10.1093/jac/dkq122Test
http://jac.oxfordjournals.org/cgi/content/short/dkq122v1Test

المؤلفون: Ritchie, N. D.¹, Irvine, S. C.¹, Helps, A.², Robb, F.³, Jones, B. L.⁴, Seaton, R. A.³

المصدر: QJM: An International Journal of Medicine. Mar2017, Vol. 110 Issue 3, p155-161. 7p.

مصطلحات موضوعية: *ANTIBIOTICS, *MORTALITY, *GRAM-negative bacteria, *BETA-lactamase inhibitors, *GENTAMICIN, *THERAPEUTICS

مستخلص: Introduction: Antimicrobial stewardship has an important role in the control of Clostridium difficile infection (CDI) and antibiotic resistance. An important component of UK stewardship interventions is the restriction of broad-spectrum beta-lactam antibiotics and promotion of agents associated with a lower risk of CDI such as gentamicin. While the introduction of restrictive antibiotic guidance has been associated with improvements in CDI and antimicrobial resistance, evidence of the effect on outcome following severe infection is lacking. Methods: In 2008, Glasgow hospitals introduced a restrictive antibiotic guideline. A retrospective before/after study assessed outcome following Gram-negative bacteraemia in the 2-year period around implementation. Results: Introduction of restrictive antibiotic guidelines was associated with a reduction in utilization of ceftriaxone and co-amoxiclav and an increase in amoxicillin and gentamicin. Approximately 1593 episodes of bacteremia were included in the study. The mortality over 1-year following Gram-negative bacteraemia was lower in the period following guideline implementation (RR 0.852, P=0.045). There was no evidence of a difference in secondary outcomes including ITU admission, length of stay, readmission, recurrence of bacteraemia and need for renal replacement therapy. There was a fall in CDI (RR 0.571, P=0.014) and a reduction in bacterial resistance to ceftriaxone and co-amoxiclav but no evidence of an increase in gentamicin resistance after guideline implementation. Conclusion: Restrictive antibiotic guidelines were associated with a reduction in CDI and bacterial resistance but no evidence of adverse outcomes following Gram-negative bacteraemia. There was a small reduction in one year mortality. [ABSTRACT FROM AUTHOR]